Hot self-funding takes from SIIA's 2023 National Conference

The Self-Insured Institute of America’s (SIIA) 2023 national conference took place in the heart of the Valley Of The Sun, but the spicy food and warm weather weren’t the only things making attendees sweat: There were also plenty of hot takes about the future of benefits and health care. Here are some top highlights:

Mike Walsh, CEO of Tomorrow, during his opening keynote “Planning For AI-Powered Organizations”

“We underestimate how different the future will look with AI. The last 10 months have seen more change than the previous 10 years when it comes to AI. By 2033, we are going to live in a radically different society and insurance ecosystem. Organizations are going to compete on their ability to provide compelling algorithmical experiences. The real value of AI for organizations won’t be incremental shifts, it will be rethinking what is even possible.”

 “What’s going right and wrong with federal price transparency?” featuring Chris Condeluci Ahmed Marmoush Cheryl Matochik and Traci McGinnis

“The transparency rules and regulations haven’t transformed health care and benefits, but they’ve certainly moved the ball forward… If transparency is ever going to be truly transformative, we need to empower plan sponsors to be able to negotiate with providers using true pricing and quality data. We must create apples-to-apples comparisons for employers, make it understandable, and keep it all from becoming overwhelming … Benefits advisors and consultants working directly with employers is how we’re going to make a difference.”

“Health systems and self-insured payers — an evolving relationship” featuring Lesley Boughner Ernie Clevenger Amy Gasbarro and Kevin Seelman

“Ultimately, we want a relationship with employers and we need to have some of them outside of our relationships with the BUCAHs. We have to figure out a way to diversify, just like everyone else .. The direct-to-employer strategy is a way for us to differentiate ourselves and have a seat at the table to figure out what is important to each employer’s employee population … Many of the groups we work with are 30 to a few hundred lives, so direct contracting is available to more than just big employer groups … In addition to cost savings, direct contracting can give employers better access to care, higher quality care, and access to more data.”

“Gag clauses and fiduciary responsibilities: Where’s our claims data?” featuring Julie Selesnick Denny Weinberg Chris Condeluci and Dawn Cornelis

“The fight for access to data reached a fevered pitch in the past decade, leading to a barrage of lawsuits and even Congress getting into the act. Although the original versions of provisions have been watered down since then, progress was made, although it is still running into complications and stumbling blocks.

“A number of lawsuits have been filed in an effort to gain access to claims data. At times, it has become very tense, because the carriers often really don’t want to give up this information … The CAA and Gag Clause Prohibition have fueled a new desire for employers, individuals and others to get access to data. This is only the beginning, and things are starting to change. But it’s going to take a long time … The big question is, why do we have to file lawsuits in order to simply do the right thing? The CAA has been a blessing for those who are trying to move things forward.

“Benefits consultants and advisors have a huge role here and need to understand who the bad actors are. They need to be equipped on how to employ the right solutions so their clients don’t become victims … Read the cases: there are some gold nuggets of information that will help you realize some of the egregious things that are happening. These aren’t opinions; they’re facts … Price increases are becoming unsustainable and employers are increasingly asking for help. Plan sponsors and fiduciaries need their claims data to make sure they’re meeting their obligations and doing what they’re supposed to do. You can’t contract away your fiduciary responsibility, so you have to check. The law is now very clear that the plan has the right to access claims data at any time so they can be better stewards of their plans.

“All the great work that has been done so far is stagnant until we all rise and ask to simply do what is right on behalf of our members.”